컴퓨터 단층 촬영으로 진단된 미세 폐 전이가 임신성 융모종양의 예후에 미치는 영향

김석모(Seok Mo Kim),김기민(Ki Min Kim),최영삼(Young Sam Choi),김윤하(Yoon Ha Kim),최호선(Ho Sun Choi),변지수(Ji Soo Byun) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.11

Objective: CT scan is more accurate method than chest X-ray for detecting small pulmonary metastasis in GTT. About 40% of nonmetastatic GTT based on conventional chest X-ray have pulmonary metastasis detected by CT scan. However, prognostic significance of small pulmonary metastasis detected only by CT scan is not well determined. The purpose of our study is to know whether small pulmonary metastasis detected only by CT scan affect treatment outcome worse or not. Methods: Forty eight GTT patients without any metastasis and eleven GTT patients with lung metastasis as determined by conventional GTT staging studies were evaluated with CT scan of the lungs before treatment between 1989 and 1998. A total of fifty nine GTT patients were classified into true nonmetastatic and micrometastatic groups based on CT scan finding, and nonmetastatic and metastatic groups based on conventional chest X-ray finding. They all received methotrexate therapy except three patients with high risk WHO score. All their medical records were reviewed to detect any differences in the treatment outcome and prognostic factors according to the groups. Results: Fifteen of forty eight patients(31.2%) had pulmonary micrometastasis detected by CT scan. Three of thirty three patients(9.09%) in the true nonmetastatic group failed initial therapy with methotrexate while two of fifteen patients(13.3%) in the micrometastatic group failed initial therapy(p value: 0.642). Five of forty eight patients(10.41%) in the nonmetastatic group failed initial therapy while one of eleven patients(9.09%) in the metastatic group failed initial therapy(p value: 1.00). All patients who failed initial methotrexate therapy finally achieved remission with EMACO therapy regardless of their groups. There was no statistically significant difference in the other prognostic parameters among the groups. Conclusion: CT scan was a more sensitive imaging tool than chest X-ray for detecting pulmonarymetastasis in GTT. But lung micrometastasis detected by CT scan had no significant impact on the clinical outcome of patients with GTT, chest X-ray is adequate method for the detection of lung metastasis.

Targeted therapy for thyroid cancer : When and What?

김석모(Seok-Mo kim) 대한갑상선-내분비외과학회 2016 대한갑상선-내분비외과학회 학술대회 논문집 Vol.- No.-

Medroxyprogesterone acetate(MPA)에 의한 자궁내막증식증의 치료효과

김석모(Seok Mo Kim),신광식(Kwang Sik Shin),김윤하(Yoon Ha Kim),최호선(Ho Sun Choi),변지수(Ji Soo Byun) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.8

Objective : To investigate the response of hyperplastic endometrium to Medroxyprogesterone acetate according to the histologic types such as simple typical, complex typical and atypical hyperplasia. Methods: A total of 79 patients with histologically proved endometrial hyperplasia were enrolled into this prospective study between March 1996 and May 1998. Patients without atypia were placed on a regimen of cyclic therapy with 10mg MPA orally, each day for 14days per month for 3 months. In the cases in which hyperplasia did not regress , MPA was increased to 20mg. Patients with atypical hyperplasia received continuous MPA therapy, 20mg orally each day for 3 month. All patients were followed up for a minimum of 3 months and a maximum of 1 year(mean 7 months). Results : In patients with simple typical hyperplasia, 45 patients(80.4%) had regression, 11 patients(19.6%) had persistence and none had progression. In patients with complex typical hyperplasia, 10 patients(83.3%) had regression, 2 patients(16.7%) had persistence and none had progression. But, in patients with atypical hyperplasia 5 patients(45.4%) had regression, 4 patients(36.4%) had persistence and 2(18.2%) patients had well differentiated endometrial adenocarcinoma. There was no recurrence during the follow up. Conclusion : This data suggest that most women with typical hyperplasia respond to progestin therapy, but there is high failure rate of response to progestin therapy and risk of endometrial cancer in patients with atypical hyperplasia. If the young patient desires to preserve her fertility, then progestin therapy may be considered as primary treatment in patients with atypical hyperplasia. But older patients in whom fertility is not an issue, hysterectomy should be selected as treatment of choice for atypical lesion.

난소암 진단에서 도플러 파형 검사의 의의

김석모(Seok Mo Kim),최진(Jin Choe),정성일(Sung Il Chung),최호선(Ho Sun Choi),변지수(Ji Soo Byun) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.2

Objective: The aim was to assess the value of resistance index(RI) and pulsatility index(PI) to differentiate between benign and malignant ovarian tumors by color and pulsed Doppler ultrasound. Methods: 129 ovarian tumors identified with ultrasound were referred for color and pulsed Doppler ultrasound evaluation to calculate the lowest RI and PI, and the corresponding histopathologic diagnosis was recorded. Results: The intratumor artery waveforms were obtained in 37.1%(36 of 97) of benign tumors and in 91.0%(29 of 32) of the malignant group. RI and PI were lower in malignant tumors than in benign tumors(p<0.01). Also, there was a significant incremental decrease in both indices value from the benign tumor toward borderline malignancy(p<0.05) and to invasive ovarian cancer(p<0.01). But, there was no significant difference in both indices value according to the FIGO stage of ovarian malignancy. For RI cut-off value of 0.6, sensitivity and specificity were 89.7% and 91.7%; for PI cut-off value of 1.1, 86.2% and 91.7%. Therefore, the most accurate cut-off values of RI and PI were 0.6 and 1.1, respectively. Conclusion: RI and PI calculated by color and pulsed Doppler ultrasound can help in the diagnosis and selection of treatment plan of ovarian tumors, especially when the morphological finding of ovarian tumor is equivocal. And during the follow up of benign tumors, both indicies can give us the clue of malignant potential of benign tumors.

양측 난소의 성숙 기형종 중 일측에서 기원한 장형 점액성 선암과 갑상선종 유암 1 예

김석모(Seok Mo Kim),최호선(Ho Sun Choi),변지수(Ji Su Byun),김윤하(Yoon Ha Kim),김경선(Kyoung Seon Kim),임소이(So Yi Rim),김형록(Hyung Rok Kim),남종희(Jong Hee Nam) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.1

Malignant transformation of mature cystic teratoma (MCT) is an uncommon complication occuring in approximately 1-3%. Any of the constituent tissues of a teratoma has the potential to undergo malignant transformation; squamous cell carcinoma is the most commonly associated cancer, however, adenocarcinomas or carcinoid tumors arising in mature cystic teratoma are uncommon, especially simultaneously. We present an unusual case of postmenopausal women having mucinous adenocarcinoma and strumal carcinoid tumor simultaneously arising in one of bilateral mature cystic teratoma of the ovary. We suggest malignant transformation of MCT should be treated according to the management of the worst histologic diagnosis of the transformations if there are 2 or more malignancies are arised in MCT of the ovary.

조기분만 시 조직학적 융모양막염 유무에 따른 혈청 C-반응성 단백질, 태반 내 interleukin-6, 지 질과산화도 및 단백산화도

윤대석 ( Dae Seok Yoon ),김윤하 ( Yoon Ha Kim ),김철홍 ( Chul Hong Kim ),조문경 ( Moon Kyoung Cho ),김종운 ( Jong Woon Kim ),조혜연 ( Hye Yon Cho ),김석모 ( Seok Mo Kim ),강우대 ( Woo Dae Kang ),이기호 ( Ki Ho Lee ),송태복 ( Tae B 대한산부인과학회 2011 Obstetrics & Gynecology Science Vol.54 No.1

Objective: To evaluate predictive value of maternal serum white blood cells (WBCs), C-reactive protein (CRP) levels, placental interleukin-6 (IL-6), lipid peroxide, and protein carbonyl levels in preterm birth according to histologic chorioamnionitis (HCA). Methods: This cohort study included 45 cases of preterm delivery with preterm labor and intact membranes (preterm labor [PTL] group; n=16) and preterm premature rupture of membranes (preterm premature rupture of membranes [PPROM] group; n=29). Blood samples at admission and placental sample at postpartum were collected. HCA was diagnosed in the presence of neutrophils infiltration into the subamnionic space. Results: The incidence of HCA was significantly higher in PPROM group than PTL group. Maternal serum WBC and CRP levels at admission, and placental IL-6, lipid peroxide, and protein carbonyl levels in HCA group were significantly higher than group without HCA. Maternal serum CRP levels at admission, and placental IL-6, lipid peroxide, and protein carbonyl levels of PPROM group with HCA were significantly higher than PPROM group without HCA. Maternal serum CRP levels at admission of 7 days and more latency period (n=14) were significantly lowered than those of less than 7 days latency period (n=15). The cut-off points of CRP determined with the receiver operating characteristic curves was 0.875 mg/dL. Perinatal morbidity such as respiratory distress syndrome, intraventricular hemorrhage, pneumonia in HCA group was significantly higher than group without HCA. Conclusion: Maternal serum CRP on admission may be possible a predictor for duration of the latency period in PPROM.

자간전증에서 제대정맥혈장과 태반내 단백산화 촉진능 증가

김은미 ( Eun Mi Kim ),김윤하 ( Yoon Ha Kim ),안봉환 ( Bong Whan Ahn ),양성열 ( Sung Yeul Yang ),김철홍 ( Cheol Hong Kim ),조문경 ( Moon Kyoung Cho ),김석모 ( Seok Mo Kim ),송태복 ( Tae Bok Song ) 대한주산의학회 2004 Perinatology Vol.15 No.1

목적 : 단백질 산화를 잘 일으키는 cephalosporin에 의한 정상과 자간전증 임부의 제대정맥혈장과 태반내 단백산화 촉진능의 차이를 비교하고 단백산화촉진활성이 자간전증의 병태생리에 어떤 역할을 하는가 규명하고자 하였다. 연구 방법 : 임신 34주 이상의 정상 임부 12명과 자간전증 환자 12명으로부터 태아분만시 제대정맥을 채취하고 분만 후 태반조직을 얻었다. Thiobarbituric acid 반응을 이용하여 지질과산화물 농도를 측정하였고, 2,4-dinitrophenylhydrazine (DNPH) 방법을 이용하여 단백질의 carbonyl기 함량을 측정하였다. 1 mM methodmoxalactam과 cephalothin 0.2 mL에 5시간 동안 함께 부치시킨 후 생성되는 제대정맥 혈장과 태반조직 단백질의 carbonyl기 함량을 측정하였다. 결과 : 정상 임신군의 제대정맥혈장과 태반조직균질액내 지질과산화물 치는 4.9±2.1과 5.8±2.2 nmol/mg protein이었으며, 자간전증군의 제대정맥혈장과 태반조직균질액내 지질과산화물은 10.1±4.0와 8.2±3.3 nmol/mg protein으로 자간전증군에서 정상 임신군보다 모두 의의있게 높았다 (p<0.05). Moxalactam과 cephalothin과 함께 부치시켰을 때 생성되는 제대정맥 혈장의 carbonyl기 함량은 자간전증 임부에서 정상임부에 비해 의의있게 높았다(8.5±2.0 vs. 6.6±1.4 nmol/mg protein, p<0.05, 7.6±1.6 vs. 6.2±1.2 nmol/mg protein, p<0.05). Moxalactam과 cephalothin과 함께 부치시켰을 때 생성되는 태반조직 단백질의 carbonyl기 함량은 자간전증 임부에서 정상임부에 비해 의의있게 높았다(17.6±5.3 vs. 13.0±4.2 nmol/mg protein, p<0.05, 16.1±5.2 vs. 12.5±4.4nmol/mg protein, p<0.05). 제대정맥 혈장과 태반조직내 지질과산화물 농도가 증가할수록 moxalactam과 cephalothin에 부치 후 단백질의 carbonyl기 함량이 증가하는 비례적인 관계를 보였다(p<0.01). 결론 : 자간전증 임부의 제대정맥 혈장과 태반조직에서 cephalosporin에 의한 단백질의 산화적 변화가 증가되어 있으며, 이러한 단백산화촉진에 관여하는 물질로는 제대정맥 혈장과 태반조직에서 증가되어 있는 지질과산화물이 작용을 할 것으로 사료되었다. 단백산화 촉진활성의 증가는 지질과산화물질의 증가와 더불어 자간전증의 발생에 관여하고 있을 것으로 사료되었다. Objective : This study was performed to compare the prooxidative activity stimulating the protein carbonyl formation by cephalosporins in the umbilical venous and placenta of preeclampsia with that of normal pregnancy. Methods : Lipid peroxide levels in the umbilical venous plasma and placental tissue homogenates of normal pregnancy (n=12) and preeclampsia (n=12) were measured by thiobarbituric acid reaction. The basal protein carbonyl contents in the umbilical venous plasma and placental tissue homogenates of normal pregnancy (n=12) and preeclampsia (n=12) were determined by the 2,4-dinitrophenylhydrazine (DNPH) method. After samples of them were mixed and incubated up to 5 hours with 0.2 mL of 1 mM moxalactam or cephalothin, the protein carbonyl contents in them were measured by DNPH. Results : Protein carbonyls formation by moxalactam and cephalothin in the umbilical venous plasma and of women with preeclampsia were significantly higher than that of women with normal pregnancy (8.5±2.0 vs. 6.6±1.4 nmol/mg protein, p<0.05, 7.6±1.6 vs. 6.2±1.2 nmol/mg protein, p<0.05). Protein carbonyls formation by moxalactam and cephalothin in the placental tissue homogenates of women with preeclampsia were significantly higher than that of women with normal pregnancy (17.6±5.3 vs. 13.0±4.2 nmol/mg protein, p<0.05, 16.1±5.2 vs. 12.5±4.4 nmol/mg protein, p<0.05). There were significant positive correlations between lipid peroxide and cephalosporins induced protein carbonyls levels of umbilical venous plasma, and placental tissue homogenates (p<0.01). Conclusion : These results suggest that increase in the prooxidative activity stimulating the oxidative modification of proteins in placenta may be involved in the pathogenesis of preecalmpsia.

긴장성 요실금의 수술적 치료에서 Transobturator tape (TOT) 시술의 합병증에 대한 임상적 고찰

김철홍 ( Cheol Hong Kim ),조문경 ( Moon Kyoung Cho ),김종운 ( Jong Woon Kim ),김석모 ( Seok Mo Kim ),김윤하 ( Yoon Ha Kim ),오성택 ( Sung Tack Oh ),송태복 ( Tae Bok Song ),최호선 ( Ho Sun Choi ),이여일 ( Yu Il Lee ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.9

Objective: The purpose of this study was to evaluate the complications of Transobturator tape (TOT) in the surgical treatment for stress urinary incontinence and their management. Methods: From March 2005 to October 2007, 206 patients diagnosed with stress urinary incontinence were operated using TOT at Chonnam National University Hospital. We reviewed medical records and analyzed the data according to age, parity, menopausal state, concomitant operations and complications. Results: Mean age of the patients was 52.6±10.5 years and mean parity was 2.9±1.4. 91 patients (44.2%) were in postmenopausal state and 201 patients (97.6%) had other concomitant gynecologic operations. There were no intraoperative complications such as vaginal injury or bladder perforation. Postoperatively, there were 2 cases (1.0%) of vulva hematoma, 6 cases (2.9%) of urinary retention, 4 cases (1.9%) of de novo urgency and 4 cases (1.9%) of vagial erosion. Conclusion: The surgical treatment using TOT is thought to be safe and effective means for the management of stress urinary incontinence. Although rare, complications may occur, therefore surgeons must be aware of the management of each complications.

임신 중 비타민 C와 비타민 E 투여 후 임신부 정맥혈장과 제대정맥혈장내 지질과산화물, 항산화능 및 항산화 비타민 농도

김윤하 ( Yoon Ha Kim ),김종운 ( Jong Woon Kim ),김철홍 ( Chul Hong Kim ),조문경 ( Moon Kyoung Cho ),김석모 ( Seok Mo Kim ),강우대 ( Woo Dae Kang ),조혜연 ( Hye Yon Cho ),양성렬 ( Sung Yeul Yang ),안봉환 ( Bong Whan Ahn ),송태복 ( 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.11

Objective: This controlled trial investigated the effect of supplementation with vitamins C and E on the lipid peroxide, antioxidant ability, and antioxidant vitamin levels in full term maternal and umbilical venous plasma. Methods: Forty pregnant women were randomized in this study. They were nulliparous or multiparous women with history of preeclampsia or preterm premature rupture of membranes (PPROM). Twenty women were given vitamin C (1,000 mg/day) and vitamin E (400 IU/day) from 15~20 gestational weeks to delivery. The others were not given, as a control group. Maternal venous blood was obtained before vitamin supplementation and just before delivery. Umbilical venous blood was obtained after delivery. Lipid peroxide level and oxygen-radical absorbance capacity (ORAC) were measured by thiobarbituric acid reaction and Cao`s method, respectively. Ascorbic acid, uric acid, β-carotene, retinol, α-tocopherol, and γ-tocopherol were measured by high performance liquid chromatography. Results: Supplementation with vitamins C and E was associated with decrease in lipid peroxide levels and increase in ORAC values and α-tocopherol levels in maternal venous plasma. And it was also associated with decrease in lipid peroxide levels and increase in ORAC values and α-tocopherol levels in umbilical venous plasma. Conclusion: Supplementation with vitamins C and E may be beneficial in the prevention of oxidant-antioxidant imbalance origin diseases such as preeclampsia, PPROM. And it also may affect antioxidant ability of the fetus.

만삭 전 조기양막파열 임부 양수 내 지질과산화 농도와 단백산화 촉진능 변화

김윤하 ( Yoon Ha Kim ),김석모 ( Seok Mo Kim ),김철홍 ( Cheol Hong Kim ),조문경 ( Moon Kyoung Cho ),김종운 ( Jong Woon Kim ),강우대 ( Woo Dae Kang ),조혜연 ( Hye Yeon Cho ),박주미 ( Ju Mi Park ),김은경 ( Eun Kyoung Kim ),박서연 ( S 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.2

Objective: To investigate the lipid peroxide levels and protein carbonyls levels in the amniotic fluid of pregnant women with preterm premature rupture of membranes (PPROM). Methods: The lipid peroxide levels in the amniotic fluid of normal pregnancy (n=20) and pregnant women with PPROM (n=20) were measured by thiobarbituric acid reaction. The protein carbonyl contents in the amniotic fluid of normal pregnancy (n=20) and pregnant women with PPROM (n=20) were determined by the 2,4-dinitrophenylhydrazine method. After amniotic fluid of them were mixed and incubated up to 5 hours with 0.2 mL of 1mM moxalactam, cefodizime, amoxacillin, erythromycin, the lipid peroxide levels and protein carbonyl contents in them were measured. Results: 1. The lipid peroxide levels in the amniotic fluid of pregnant women with PPROM was significantly higher than that of normal pregnancy (9.74±0.48vs. 7.20±0.38nmol/mg protein, P<0.01). 2. The protein carbonyl levels in the amniotic fluid of pregnant women with PPROM was significantly higher than that of normal pregnancy (13.0±0.33 vs. 11.27±0.17 nmol/mg protein P<0.01). 3. The lipid peroxide levels and protein carbonyls formation by moxalactam in the amniotic fluid of pregnant women with PPROM was significantly higher than basal level (12.08±0.81 vs. 9.74±0.48 nmol/mg protein, 20.08±0.66 vs. 13.0±0.33 nmol/mg protein, P<0.01). 4. The lipid peroxide levels and protein carbonyls formation by cefodizime in the amniotic fluid of pregnant women with PPROM was significantly lower than basal level (5.04±0.33 vs. 9.74±0.48 nmol/mg protein, 9.76±0.35 vs. 13.0±0.33 nmol/mg protein, P<0.01). 5. There were no significant differences in the levels of lipid peroxide and protein carbonyls by amoxacillin and erythromycin in the amniotic fluid of pregnant women with PPROM between antibiotics-induced and basal levels. Conclusion: The lipid peroxidation and the protein carbonyls formation were increased in the amniotic fluid of pregnant women with PPROM. Antibiotics-induced lipid peroxide and protein carbonyl levels were changed in the amniotic fluid of pregnant women with PPROM. Further studies on our results may be beneficial in the selection of antibiotics for pregnant women with PPROM.